Xiaochuan Li, Zhong Cheng-Fan, Tang Jian-Hua, Liang Rong-Wei, Luo Shao-Jian, Huang Chun-Ming
Gaozhou People's Hospital, China.
Department of Orthopedics Surgery, Gaozhou People's Hospital, No 89, Xi-Guan Road, Guangdong 525200, China.
Pain Physician. 2017 May;20(4):E541-E550.
Our previous study demonstrated that selective nerve root block (SNRB) can influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted for decompression in diagnostic doubt patients (DDPs). However, further studies were needed to determine whether this selective decompression (SD) procedure would result in similar clinical outcomes and reduce the perioperative parameters and postoperative complications as compared to the non-selective decompression (NSD) procedure.
The specific goal of this study is to compare clinical outcomes, perioperative parameters, and complications between SD and NSD procedures in DDPs.
A retrospective control study.
Gaozhou People's Hospital.
From January 2009 to January 2011, 57 lumbar surgery patients with diagnostic doubt were retrospectively reviewed. Basic patient parameters, as well as perioperative and postoperative data were compared between the selective and non-selective decompression groups. Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and JOA recovery rates.
Both groups showed significant improvement in VAS, ODI, and JOA scores between preoperative and postoperative measurements. The differences in VAS and ODI scores between groups were not significant at 3 and 60 months postoperatively (both P > 0.05). In addition, there was no significant difference in JOA recovery rate (P = 0.659) and survival rate (P = 0.586) during the 60 months following surgery. However, distinctly superior perioperative parameters (operation time and hospital stay, blood loss and drainage volume, laminectomy numbers, and fusion segment numbers) were observed in the SD group (P < 0.001 for each score). Moreover, the SD-treated group experienced significantly fewer adverse events postoperatively (P = 0.036).
The limitations of this study lie in the size of the study and selection of patients and in the fact that it was not feasible to include all cases of diagnostic doubt.
On the basis of the 5-year follow-up data, we suggest that the SD procedure guided by SNRB is an effective and safe method for the surgical treatment of DDPs. This procedure produces superior perioperative parameters when compared with the conventional NSD procedure, but has a comparable clinical outcome. Moreover, the benefits of SD surgery include fewer perioperative and postoperative complications.
我们之前的研究表明，选择性神经根阻滞（SNRB）可通过指导对诊断存疑患者（DDPs）中目标神经根减压的选择，来影响腰椎手术的决策。然而，需要进一步研究以确定与非选择性减压（NSD）手术相比，这种选择性减压（SD）手术是否会产生相似的临床结果，并降低围手术期参数和术后并发症。
本研究的具体目标是比较DDPs中SD和NSD手术的临床结果、围手术期参数及并发症。
一项回顾性对照研究。
高州市人民医院。
回顾性分析2009年1月至2011年1月期间57例诊断存疑的腰椎手术患者。比较选择性减压组和非选择性减压组患者的基本参数、围手术期及术后数据。采用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）、日本矫形外科学会（JOA）评分及JOA恢复率评估临床结果。
两组患者术前与术后的VAS、ODI及JOA评分均有显著改善。术后3个月和60个月时，两组间VAS和ODI评分差异均无统计学意义（均P>0.05）。此外，术后60个月内JOA恢复率（P=0.659）和生存率（P=0.586）差异均无统计学意义。然而，SD组的围手术期参数（手术时间、住院时间、失血量和引流量、椎板切除数量及融合节段数量）明显更优（各评分P<0.001）。此外，SD治疗组术后不良事件明显更少（P=0.036）。
本研究的局限性在于研究规模和患者选择，且纳入所有诊断存疑病例不可行。
基于5年随访数据，我们认为SNRB引导下的SD手术是治疗DDPs的一种有效且安全的方法。与传统NSD手术相比，该手术围手术期参数更优，但临床结果相当。此外，SD手术的益处包括围手术期和术后并发症更少。
